Tendências e fatores associados ao custo da saúde privada no Brasil: uma análise via modelo Getzen expandido para o envelhecimento da população

Abstract

The cost of private health care in Brazil has already become a prominent variable due to its growing trend, and in this context, a number of factors associated with such costs stand out. The Getzen Model seeks to quantify the role of each factor in the growth of health costs, and initially consists of the decomposition of health costs into the variables: real per capita income, inflation and population growth, in addition to residual growth, share of health growth. cost that is not explained by the other variables, and which, for Getzen, is synonymous with technology. The objective of this research is to analyze the variable “cost of private health care operators” in Brazil between 2002 and 2017 through the use of the decomposition proposed by Getzen. A priori, decomposition procedures are performed with the original components. The results show that residual growth is a variable that stands out as a component of costs, even surpassing inflation in some periods, while population growth showed a small participation as a component of health spending. In the Getzen Model, residual growth is a synonym for technology, which converges to a steady state over the long term. Thereafter, growth in the cost of health equals growth in real GDP per capita plus inflation, as the share of population growth is small. In the Brazilian case, however, the use of residual growth as an exclusive synonym for technology is disputable, as other variables are often cited as factors associated with health costs, besides those explicit from the Getzen Model. Examples include population aging, moral hazard and judicialization. This paper chose to propose a new version of the Getzen Model, including the inclusion of an aging indicator as an explicit variable, due to the relevance that aging has in the literature and also because there is already an accepted indicator in the literature on the subject. This model was called the Expanded Getzen Model for Aging. This decomposition shows that the inclusion of aging generally reduces the magnitude of residual growth compared to the original model. According to the new model, even if technology converged in the long run, population aging would continue to raise health costs above real per capita income growth and inflation. However, it is noteworthy that even though aging is now an explicit variable, the waste may still have other components besides technology, which also put pressure on costs. As private health tuition adjustments are intended to reflect sector costs, the trend of cost growth above real income growth and inflation is reflected in readjustments, so that in the long run private health tends to be increasingly expensive, a fact that jeopardizes the sustainability of thesector and makes it essential for operators to seek measures to face this scenario.